Urinary tract infections (UTI) in women are a common occurrence. 1 in 2 women will experience a UTI at some point in the lives, and up to a quarter of these women may experience multiple repeated urinary infections.
The majority of women with uncomplicated UTI will usually experience a burning sensation on urination. This is often associated with (1) frequent and urgent visits to the bathroom to urinate; (2) small volumes of urine being passed each time; (3) lower abdominal pain or discomfort; and / or (4) passage of bloody urine. In atypical cases, the bacterial infection in the bladder may ascend up the ureters to affect the kidneys, known as acute pyelonephritis. In this scenario, fever, chills and flank pain may be experienced. If the female notices associated vaginal discharge, itch or foul odour, this is likely due to inflammation of the vagina (vaginitis) or urethra (urethritis).
The most frequent route for bacteria to gain entry into the female urinary tract are ascending infections of bacteria from the peri-anal area or the vagina, often after sexual intercourse. Commonly identified types of bacteria in typical female UTIs include Escherichia Coli; Proteus; Klebsiella, Pseudomonas and Enterococcus.
Fig 1: E.coli bacteria is frequently responsible for urinary tract infections.
Patients who experience 2 or more urinary tract infections within a 12-month period are diagnosed with having recurrent urinary tract infections. Common causes for such recurrent infections include:
You should consult your family doctor, gynaecologist or urologist immediately when you start to experience the abovementioned symptoms. If this is your first episode of UTI symptoms, your doctor will usually ask you a detailed medical history to identify possible causes. He will ask you for a sample of your urine to send to the laboratory for urine analysis and culture. If you are not having high fevers, he will usually prescribe a short 3-5 day course of oral antibiotics to treat the likely bacteria in your urinary tract. Commonly prescribed antibiotics include ciprofloxacin, nitrofurantoin, and trimethroprim / sulphamethozaxole. Once your urine culture result is available, he may contact you to substitute your treatment to the most appropriate antibiotic to optimize eradication of the offending bacteria.
If you continue to experience recurrent UTI symptoms more than twice in a 12-month period despite completing the appropriate antibiotics, you should request for further evaluation of your urinary tract. Your family doctor will usually refer you on to a urologist, who will arrange some/ all of the following tests to identify correctable causes:
Once the abnormality in the urinary tract is identified, appropriate treatment may then be advised and commenced to prevent future recurrences.
Fig. 2. A. 3-dimensional reconstruction on CT urogram with intravenous contrast, showing up any abnormalities of the kidneys, ureters and bladder. B. Flexible cystoscopy of the bladder being performed by the urologist.
Yes! In women aged between 25-45 years, UTIs most commonly occur within 1-2 days after sexual intercourse. If this is a repeated pattern, such females should observe the following measures to minimize recurrent infections:
In postmenopausal women with recurrent UTIs, they should consider their urologist or gynaecologist to assess the vagina and cervix to rule out early cancers or atrophic vaginitis. In the latter, topical oestrogen creams can improve the health of the vaginal lining and reduce the incidence of colonization by aggressive bacteria.
In women whose UTIs are not related to sexual intercourse, they may consider self-directed therapy. Here, patients are given a 3-day course of antibiotics by their doctors to keep on standby, and they can start treatment immediately once they recognize the onset of their familiar UTI symptoms. However, they must consult their doctors should their symptoms persist after the course of antibiotics has ended. Another popular remedy is to take regular cranberry juice / supplements, although this practice has still not been scientifically proven to reduce the incidence of UTIs3.
1. Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Canadian Urological Association Journal 2011; 5(5): 316-322.
2. Kodner CM, Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. American Family Physician 2010; 82(6): 638-643.
3. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012; DOI: 10.1002/14651858.CD001321.pub5.